From Vincent Iannelli, M.D.,
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Most people think of Halloween as a time for fun and treats. However, roughly four times as many children aged 5-14 are killed while walking on Halloween evening compared with other evenings of the year, and falls are a leading cause of injuries among children on Halloween. Many Halloween-related injuries can be prevented if parents closely supervise school-aged children during trick-or-treat activities.

Parents can help prevent children from getting injured at Halloween by following these safety tips from the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the National Safety Council.

Children should:

• Go only to well-lit houses and remain on porches rather than entering houses.
• Travel in small groups and be accompanied by an adult.
• Know their phone number and carry coins for emergency telephone calls.
• Have their names and addresses attached to their costumes.
• Bring treats home before eating them so parents can inspect them.
• Use costume knives and swords that are flexible, not rigid or sharp.

When walking in neighborhoods, they should

• Use flashlights, stay on sidewalks, and avoid crossing yards.
• Cross streets at the corner, use crosswalks (where they exist), and do not cross between parked cars.
• Stop at all corners and stay together in a group before crossing.
• Wear clothing that is bright, reflective, and flame retardant.
• Consider using face paint instead of masks. (Masks can obstruct a child's vision.)
• Avoid wearing hats that will slide over their eyes.
• Avoid wearing long, baggy, or loose costumes or oversized shoes (to prevent tripping).
• Be reminded to look left, right, and left again before crossing the street.

Parents and adults should:

• Supervise the outing for children under age 12.
• Establish a curfew (a return time) for older children.
• Prepare homes for trick-or-treaters by clearing porches, lawns, and sidewalks and by placing jack-o-lanterns away from doorways and landings.
• Avoid giving choking hazards such as gum, peanuts, hard candies, or small toys as treats to young children.
• Inspect all candy for safety before children eat it.
• Parents and adults should ensure the safety of pedestrian trick-or-treaters
• Make sure children under age 10 are supervised as they cross the street.
• Drive slowly.
• Watch for children in the street and on medians.
• Exit driveways and alleyways carefully.
• Have children get out of cars on the curb side, not on the traffic side.
• And a few tips about pumpkins:
• Carve pumpkins on stable, flat surfaces with good lighting.
• Have children draw a face on the outside of the pumpkin, then parents should do the cutting.
• Place lighted pumpkins away from curtains and other flammable objects, and do not leave lighted pumpkins unattended.

Who Is Affected?

A study conducted by the Centers for Disease Control and Prevention (CDC) showed that during 1975-1996, the number of deaths among young pedestrians was four times higher on Halloween evening when compared with the same time period during all other evenings of the year. Halloween poses special risks to young pedestrians. For example, most of the time children spend outdoors is typically during daylight hours. However, Halloween activities often occur after dark. Also, children engaged in "trick or treat" activities frequently cross streets at mid-block rather than at corners or crosswalks, putting them at risk for pedestrian injury.

Many parents overestimate children's street-crossing skills. The pedestrian skills of children are limited by several factors related to their physical size and developmental stage. For instance, young children may lack the physical ability to cross a street quickly, and their small size limits their visibility to drivers. Children are likely to choose the shortest rather than the safest route across streets, often darting out between parked cars. In addition, young children do not evaluate potential traffic threats effectively, cannot anticipate driver behavior, and process sensory information more slowly than adults.